Provider Demographics
NPI:1073626362
Name:MARTINO, SILVANA (DO)
Entity Type:Individual
Prefix:
First Name:SILVANA
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 560W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-582-7900
Mailing Address - Fax:310-582-7946
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 560W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-582-7900
Practice Address - Fax:310-582-7946
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6503207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6503OtherMEDICAL LICENSE
CAW15185AOtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CAW15185OtherMEDICARE PTAN - FACILITY
CAB45772Medicare UPIN
CAW15185OtherMEDICARE PTAN - FACILITY
CAW20A6503CMedicare PIN